Active NPI
John Goodrich, DDS MS
- Endodontics
- Des Moines, IA
National Provider Identifier
1679622922
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 6461
- Practice address
- 4919 Douglas Ave
Suite 12
Des Moines, IA 50310 - Phone
- (515) 276-3664
- NPI assigned
- Jan 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 6461 | IA | Primary |
Addresses
Primary practice location
4919 Douglas Ave
Suite 12
Des Moines, IA 50310
Mailing address
4919 Douglas Ave
Suite 12
Des Moines, IA 50310
Phone (515) 276-3664
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0162909 | Medicaid | IA | |
| 162909 | Other | IA | DELTA DENTAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6461 | IA | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1513814400000",
"number": "1679622922",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4919 DOUGLAS AVE",
"address_2": "SUITE 12",
"city": "DES MOINES",
"state": "IA",
"postal_code": "50310",
"telephone_number": "515-276-3664"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4919 DOUGLAS AVE",
"address_2": "SUITE 12",
"city": "DES MOINES",
"state": "IA",
"postal_code": "50310",
"telephone_number": "515-276-3664"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODRICH",
"first_name": "JOHN",
"name_prefix": "Dr.",
"credential": "DDS MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-09",
"last_updated": "2017-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "IA",
"license": "6461",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0162909",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DELTA DENTAL",
"identifier": "162909",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Des Moines, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.